MEDICARE: NORCREST MEDICAL EQUIPMENT & SUPPLIES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1629173455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORCREST MEDICAL EQUIPMENT & SUPPLIES LLC

Provider Business Mailing Address
First Line	:	15400 GRAND RIVER AVE
Second Line	:	SUITE 11
City	:	DETROIT
State	:	MI
Zip	:	48227-4124
Country	:	US
Telephone Number	:	313-835-6884
Fax Number	:	313-835-6895

Provider Business Practice Location Address
First Line	:	15400 GRAND RIVER AVE
Second Line	:	SUITE 11
City	:	DETROIT
State	:	MI
Zip	:	48227-4124
Country	:	US
Telephone Number	:	313-835-6884
Fax Number	:	313-835-6895

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. ATTAESSIEN A UBOKUDOM
Credential	:
Telephone Number	:	313-835-6884

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	08/22/2020

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